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General NPI Number Information
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NPI Number | 1487785028
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Entity Type | Individual
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Provider Name | MARK S. SMASAL PHD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 604 N PINION HILLS DR
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City | DAMMERON VALLEY
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State | UT
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Zip | 84783-5180
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Country | US
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Telephone | 702-994-3890
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1430
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City | ST GEORGE
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State | UT
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Zip | 84771-1430
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0364
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 277642-2501
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License Number State | UT
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